Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors
The Journal of thoracic and cardiovascular surgery
Norwood operation; hybrid; hypoplastic left heart syndrome; palliation; single ventricle
OBJECTIVE: The study objective was to analyze outcomes of the hybrid strategy for ductal-dependent systemic circulation consisting of bilateral pulmonary artery banding with or without ductal stenting followed by delayed Norwood-type palliation or comprehensive stage II operation in high-risk neonates. METHODS: A retrospective analysis was performed between December 2017 and March 2021. Thirty high-risk neonates underwent palliation with bilateral pulmonary artery banding: 11 with prostaglandin therapy and 19 with ductal stenting. Median (range) age and body weight of patients at hybrid stage I were 3 days (0-43) and 2.9 kg (1.1-4.2), respectively. Operative and interstage mortality, morbidity, and reintervention rates were assessed. RESULTS: Overall survival was 70% (21/30) at a median follow-up time of 9 months (range, 0-37) from hybrid stage I. Operative survival for hybrid stage I was 90% (27/30), of which 2 patients received palliative care, and there was 1 interstage death (4%, 1/27). After hybrid stage I, 37% of patients had a reintervention, and 3% (n = 1) used extracorporeal membrane oxygenation before the next stage of repair. Five patients are awaiting second-stage operation, and 9 patients are awaiting Fontan completion. CONCLUSIONS: High-risk neonates with hypoplastic left heart syndrome or its variants can be successfully palliated using the hybrid strategy and bridged to a delayed Norwood or comprehensive stage II operation with satisfactory survival. This operative approach is a promising alternative pathway for neonates deemed to be high risk due to multiple preoperative risk factors.
Ceneri, Nicolle M.; Desai, Manan H.; Tongut, Aybala; Ozturk, Mahmut; Ramakrishnan, Karthik; Staffa, Steven J.; Zurakowski, David; Donofrio, Mary T.; Downing, Tacy; d'Udekem, Yves; Jonas, Richard A.; and Yerebakan, Can, "Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors" (2022). GW Authored Works. Paper 2028.